NT pushes for its pathology model for PCEHR

Written by Kate McDonald on 16 September 2013.

The Northern Territory Department of Health is hoping that its model for posting pathology results and diagnostic imaging reports to the My eHealth Record (MeHR) will be adopted in the short term for the national PCEHR.

Debate has raged around what is the best method to post pathology results and diagnostic reports to the PCEHR following the announcement in July by former health minister Tanya Plibersek that $8 million would be allocated to designing a suitable system.

The RCPA in particular is concerned about the ramifications of atomic data from test results being separated from the pathologist's full report and interpretation.

RCPA president Yee Khong told Pulse+IT recently that the college preferred a method in which the whole report was posted as an individual document. However, industry sources say that method is very unlikely to be agreed to.

Sharon McAnelly, director of eHealth systems with the Northern Territory Department of Health, told the eHealth Interoperability Conference in Sydney last week that her team hoped the method currently being used for the Territory's MeHR would be chosen.

Ms McAnelly said NEHTA and the Department of Health and Ageing (DoHA) were planning to have pathology and DI ready for the PCEHR by next April, when the fifth release of the system was due to be rolled out.

The NT is working on what it calls the M2N project, in which the MeHR (M) will be rolled into the national PCEHR (N) by that date. The NT is planning to go live with its combined system on April 28, two weeks after release five of the PCEHR is due.

“These are critical documents for our transition project,” Ms McAnelly said. “At the moment, the model is that the pathology results come into the inbox, the clinician witnesses those results, they make a decision about consent and they post them to the MeHR.

“We want to take that strategy forward as a temporary strategy for the PCEHR. I think that in the long term it would make perfect sense if they came straight from pathology companies, but the transition strategy for us is that they come into our clinical information systems and we provide the authority to post them by witnessing them, and then we pump them to the MeHR.

“This is still under consultation so it's not a decision, but we are hoping to move that to the PCEHR. I don't see that as a long-term model. The model that they are discussing is that it still comes to the clinician's inbox, but they then send an authority to post to the pathology company, and the pathology company can then post. All of that is still under consultation.”

Ms McAnelly said one of the major challenges of the M2N project was resistance from users of the MeHR to moving to the national system.

“For the NT this is quite challenging, because we had a reliable, trustworthy system that our clinicians and our consumers were very happy with. I remember going to a meeting and someone saying 'the PCEHR doesn't have enough information for our needs, our system is better and we are not moving.'

“What we worked towards to overcome any resistance from our clinicians moving from the MeHR to the PCEHR was to make sure that what was sent to the two repositories was the same, and it is, so we are very dependent on getting the pathology results and diagnostic imaging reports.”

Ms McAnelly said there were approximately 60,000 patients with an MeHR, predominantly indigenous people in the NT, northern South Australia and the Kimberley region. There are 9000 authorised clinical users across 130 sites, and the most recent figures show that 1000 clinicians were accessing the MeHR per month, with about 42,400 views per month.

“Since we started in 2005 up to the current year, views increased quite rapidly in about 2009-10 and have continued. If we compare that with what we expect to see with the PCEHR, it won't be 10 years, it will be more like four or five. Getting the documents up there, that is the pot of gold.”

The Northern Territory has not yet managed to begin sending discharge summaries to the PCEHR, but was hoping to use the Healthcare Information and PCEHR Services (HIPS) technology designed by the South Australian government.

Ms McAnelly said HIPS was able to simplify some of the interactions with the PCEHR particularly for the acute care sector. SA Health is using HIPS to send discharge summaries to the PCEHR from nine of its public hospitals.

David Bunker, NEHTA's head of architecture, told the conference he planned to make the HIPS source code available “as it is a good way to link to the national infrastructure and is relatively simple”.

Ms McAnelly said NT Health was also working on a combined viewer so clinicians can see both the MeHR and the PCEHR together, but that the intention was that the PCEHR would be the primary eHealth record.

However, the NT is also building a new view of shared health summaries for NT residents that is not planned for the rest of the country. The view will show the latest health profile – which is what shared health summaries are called in the MeHR – from each clinic the patient has attended.

“In the Territory, you may have been to the same clinic for the last two years, but you may have been to another two and a half years ago and they noticed something that wasn't picked up by your local clinic,” she said.

“In the MeHR you can see the latest health profile from each clinic. We don't want that to be lost in the noise.”

She said release five of the PCEHR was due on April 15 next year, and the NT planned to go live with its merged MeHR/PCEHR on April 28, but that was dependent on NEHTA and DoHA getting pathology results and diagnostic imaging, and some other documents, live on those dates.

“We are confident that the PCEHR can be the primary document for MeHR consumers if they get all of those bits and pieces,” she said.